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The safety and effectiveness of bivalirudin in female patients with acute myocardial infarction undergoing primary angioplasty: A subgroup analysis of the BRIGHT trial
Author(s) -
Liang Zhenyang,
Li Yi,
Wang Jingping,
Wang Dongmei,
Wang Shouli,
Ma Likun,
Liu Huiliang,
Yang Lixia,
Stone Gregg W.,
Han Yaling
Publication year - 2016
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26407
Subject(s) - bivalirudin , medicine , conventional pci , tirofiban , myocardial infarction , percutaneous coronary intervention , clinical endpoint , cardiology , subgroup analysis , incidence (geometry) , randomized controlled trial , confidence interval , physics , optics
Background Being female is an independent predictor of adverse events during percutaneous coronary interventions (PCI). Objective To evaluate the safety and efficiency of bivalirudin during emergency PCI in female patients with acute myocardial infarction (AMI). Methods The present study was a subgroup analysis of the randomized Bivalirudin in Acute Myocardial Infarction vs. Heparin and GPI plus Heparin (BRIGHT) trial. A total of 392 female patients enrolled in the BRIGHT trial were assigned to receive bivalirudin with post‐procedure dose infusion ( n = 127) or heparin with or without tirofiban ( n = 265). The primary efficiency endpoint was 30‐day net adverse clinical events (NACEs). The secondary efficiency endpoints were 30‐day major cardiac and cerebral events (MACCEs) and bleeding events defined according to Bleeding Academic Research Consortium (BARC) definitions. Results For female patients, bivalirudin treatment was associated with significantly lower incidences of 30‐day NACEs (6.3% vs. 21.5%, P < 0.001), any bleeding (2.4% vs. 12.8%, P = 0.001) and BARC 2–5 type bleeding (1.6% vs. 7.2%, P = 0.021) compared with the control regimen. The incidence of MACCEs (3.4% vs. 9.4%, P = 0.055) and stent thrombosis (0% vs. 1.1%, P = 0.229) were comparable between the two groups. Multivariate analysis showed that bivalirudin (OR: 0.245, 95% CI: 0.113–0.532, P < 0.001), transradial access (OR: 0.119, 95% CI: 0.067–0.211, P < 0.001), and statin (OR: 0.254, 95% CI: 0.08–0.807, P = 0.02) were independent protective factors for 30‐day NACEs in female patients. Conclusions The use of bivalirudin during emergency PCI for AMI in female patients significantly reduced the bleeding risk with anticoagulation effects compared with heparin with or without tirofiban. © 2016 Wiley Periodicals, Inc.